Triptan Allergies: Fact or Fiction?

I have used all triptans extensively over 25 years since Imitrex (sumatriptan) debut in the early 1990’s both as a patient and physician. I also participated in the half of the clinical trials. So I think I am qualified to safely say that this class of drugs has never been considered to be prone to cause allergic reactions. So why the sudden concern and /or apparent increase in allergic reactions to this class?

Is there truth to this?

Let’s examine what we know.

Imitrex is the only triptan which has a sulfa component of which there are many people with this allergy including myself. Despite this fact, having a sulfa allergy has never been a deterrent for its use in my field. Neither have pharmacists ever mentioned any problems or contraindications, as they do for many other drugs I have used.

Side effects of triptans:

  • Flushing sensation
  • Chest tightness
  • Tingling sensation
  • Nausea
  • Tightness of throat
  • Skin reaction if injection given
  • Palpitations

Potential for misconstrued allergic reaction

All of these can be misconstrued as an ‘allergic reaction’ to the untrained eye (happens more often than not). The key is that it happens to all people taking these drugs to some degree. However, these are all common side effects which subside readily in most people with symptoms dissipating within an hour (usually much quicker). In my experience, Imitrex appears to have more pronounced side effects particularly if injected or at doses higher than 50mg. Even though there is a relative contraindication for combining MAO inhibitors (e.g. Azilect) or SSRI’s (e.g. Lexapro), I take both without problems and have had many patients on dual drug combination without incident.

The thing that can make triptans dangerous to use is actually the history of the patient like having uncontrolled blood pressure, hemiplegia, brainstem migraines with a speech impediment, cardiac problems, and strokes.

Possible explanations for allergic reaction

As opposed to a side effect which happens to all people, an allergic reaction happens to only a few –mounting an immune response. Aside from the above-mentioned symptoms, patients can have a fever, elevated white blood cell count and other abnormal blood work, as well as swelling. The only incident I have witnessed was in my own child when her brand name Maxalt was changed to generic. She suffered a ‘hypersensitivity reaction' which is an exaggerated response or the opposite of what is expected. Usually, this kind of reaction is seen with histamines especially in children. The increase in the occurrence of hypersensitivities and perhaps actual allergies could be due to the common usage of generic substitutes.

Generic drugs only have to have the desired active drug within 20% (more or less) of the variation which means that you may get a drug that is only 80% effective or 120% at higher increased risk for more profound side effects. In my case, the generic was less effective than the brand. Instead of one tablet breaking my headache it took 2-3 tablets for the same type of headache. Besides variation in the percentage of active compound, the other chemicals which make up the drug can vary widely from manufacturer to manufacturer because generic drugs are not scrutinized by FDA - many of whom come from outside of the US. This can cause a potential host of allergic reactions when other ingredients are added to the mix. Personally, out of companies which produce generic drugs, I've found Teva is by far the most consistent from batch to batch.

Bottom line

Allergic reactions are extremely rare with this class even with sulfa component. If there is a problem, it's most likely due to other components of generic products in which case changing to a different generic or different brand could resolve the problem. If a true reaction exists, consider using alternative treatments such as Botox. I find that taking nasal spray lessens side effects of tingling sensations and tightness in the throat and chest while these symptoms are worse with injections/and with sumatriptan.

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